Quality of Anticoagulation With Phenprocoumon and Warfarin in Left Ventricular Assist Device Patients: A Multicenter Study

Abstract

Anticoagulation in left ventricular assist device (LVAD) patients is essential to prevent hemocompatibility-related adverse events (HRAEs) but is challenging due to individual variability in dose-response and the small therapeutic window. Primary outcomes were international normalized ratio (INR) time in therapeutic range (TTR) and percentage of tests in range over 1 year after the first follow-up visit (FFUV), and secondary outcomes included all-cause mortality and HRAEs risk factors among phenprocoumon and warfarin users. This retrospective, multicenter study included 179 patients (age: 57.4 ± 11.8 years; female: 23.5%; HeartMate 3/HVAD: 50.8%/49.2%) implanted at the Medical University of Vienna (n = 102 phenprocoumon) and University of Chicago (n = 77 warfarin). Phenprocoumon users had a significantly higher TTR (64.9 ± 16.1% vs. 37.7 ± 21.8%, p < 0.001). One year survival (p = 0.65) and freedom from HRAE (p = 0.54) were comparable for both drugs. A multivariate analysis associated female gender (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.12–4.11; p = 0.021), no beta blockers at FFUV (HR, 2.16; 95% CI, 1.03–4.52; p = 0.042), gastrointestinal bleeding (GIB) preimplant (HR, 3.41; 95% CI, 1.32–9.45; p = 0.018), and time between INR tests (HR, 0.85; 95% CI, 0.74–0.99; p = 0.03) with a higher risk of HRAEs. To conclude, phenprocoumon versus warfarin users had better anticoagulation quality. Female gender, longer time between INR tests, no beta blockers at FFUV, and GIB preimplant were independent risk factors for HRAEs during LVAD support. Visual Abstract: Summary of key results. INR, international normalized ratio; TTR, time in therapeutic range; PTR, percentage of tests in range; HRAE, hemocompatibility-related adverse event; FFUV, first follow-up visit; GIB, gastrointestinal bleeding; HR, hazard ratio. http://links.lww.com/ASAIO/A961